New day in court for health reform

The health care reform law confronts its most high-profile and politically charged challenge in a Florida courtroom today, just three days after a federal judge in Virginia struck down a piece of the law in a similar case.

Twenty states plan to present oral arguments today that Congress overstepped its bounds when it passed the legislation, which requires nearly all Americans to buy insurance and states to expand their Medicaid programs.

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The federal government counters that Congress was well within its legal authority when it passed President Barack Obama’s signature legislative accomplishment in March.

The lawsuit’s backers are hoping Judge Roger Vinson declares the law unconstitutional and stops the federal government from enacting the law – a step further than Judge Henry Hudson went in the Virginia case. The Supreme Court is widely expected to make the ultimate ruling on the issue.

The lawsuit is brought by attorneys general and governors in 20 states – all but one represented by Republicans – and the National Federation of Independent Business, a small business lobbying group.

The question at the crux of the case is whether not buying health insurance qualifies as something Congress can regulate under the Commerce Clause.

The states and NFIB argue that Congress has no authority to require people to buy insurance, a major provision of the health care overhaul. They say that while Congress is allowed to regulate business activity, it has no right to regulate inactivity, or people who decline to buy insurance.

The federal government plans to argue that Congress has every right to regulate people who decline to buy insurance because unlike in other industries, it’s fair to assume that every single person will need health care at some point in his or her life. If they’re not insured, their costs have to get picked up by other consumers, and this makes them part of the insurance market.

The arguments are similar to those in approximately two dozen health care reform lawsuits that have been filed across the country. In addition to the Virginia case, two judges have upheld the law and 12 other cases have been thrown out on technicalities.

Florida Attorney General Bill McCollum, who is leaving office next month, filed the suit being heard today in U.S. District Court in the Northern District of Florida shortly after the bill was signed into law in March. In October, Judge Vinson said he would allow most of the case to advance to oral arguments.

Like the Virginia case, today’s case in Florida challenges the “individual mandate.” The requirement to buy insurance, which doesn’t go into effect until 2014, is considered a lynchpin to the entire health care overhaul. Not only does it help cover millions of uninsured people, it brings young and healthy people into the insurance pool.

Having more people in the pool helps balance out new costs insurers will face as it won’t be able to turn down expensive customers with pre-existing medical conditions or place limits on benefits under the reform law.

“We look at it as the basis by which we can address the important issues like the discrimination against those with a preexisting condition,” White House spokesman Robert Gibbs said in defense of the requirement. “We look at it as how you deal with uncompensated care with people going to the emergency room and everyone paying for it as a result of that.”